Medicaid reimbursement for prenatal smoking intervention influences quitting and cessation

Petersen, Ruth; Garrett, Joanne M.; Melvin, Cathy L.; Hartmann, Katherine E.

doi:10.1136/tc.2005.012187

Cited by 31 publications

(28 citation statements)

References 25 publications

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“…Studies (41-45) have consistently found that higher cigarette taxes reduce the prevalence of prenatal smoking and the number of LBW, PTB and SIDS cases, and two studies (42, 43) found the highest price sensitivity for younger pregnant women. Medicaid policies supporting pharmacotherapy and behavioral therapy (46, 47) and more generally behavioral interventions (48, 49) have been found effective in reducing prenatal smoking. Other potentially effective policies are raising the minimum legal purchase age for tobacco to 21 (50), and media campaigns and graphic health warnings directed at discouraging maternal smoking.…”

Section: Discussionmentioning

confidence: 99%

Disparities in Maternal Child and Health Outcomes Attributable to Prenatal Tobacco Use

Mohlman

Levy

2015

Matern Child Health J

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Objectives Previous estimates of smoking-attributable adverse outcomes, such as preterm births (PTBs), low birth weight (LBW) and Sudden Infant Death Syndrome (SIDs) generally do not address disparities by maternal age, racial/ethnic group or socioeconomic status (SES). This study develops estimates of smoking-attributable PTB, LBW and SIDS for the US by age, SES and racial/ethnic groupings. Methods Data on the number of births and the prevalence of PTB, LBW and SIDS were used to develop the number of outcomes by age, race/ethnicity, and SES. The prevalence of prenatal smoking by age, race/ethnic and education and the relative risk of outcomes for smokers were used to calculate smoking-attributable fractions of outcomes. Results Prenatal smoking among ages 15-24 is above 12%, with 20-24 year olds representing at least 35% of PTB, LBW SIDS cases. Women with a high school education or less represented more than 50% of PTB and LBW births, and 44% of SIDS cases. While non-Hispanic Whites had the majority of smoking-attributable outcomes, non-Hispanic Blacks represented a disproportionately high percentage of PTBs (18%), LBW births (22%), and SIDS cases (13%). Conclusions: Reducing prenatal smoking has the potential to reduce adverse birth outcomes and costs with long-term implications, especially among the young, non-Hispanic Blacks and those of lower SES. Stricter tobacco control policies, especially higher cigarette taxes, higher minimum purchase ages for tobacco and improved cessation interventions can help reduce disparities and the cost to insurers, especially public costs through Medicaid.

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Section: Discussionmentioning

confidence: 99%

Disparities in Maternal Child and Health Outcomes Attributable to Prenatal Tobacco Use

Mohlman

Levy

2015

Matern Child Health J

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“…Two previous studies have focused solely on women before, during, or after pregnancy. An earlier study (Petersen, Garrett, Melvin, & Hartmann, 2006) linked 1998 coverage cessation data to 1998-2000 PRAMS data and found that quit rates were significantly higher in states with Medicaid coverage of pharmacotherapies or counseling than in states without cessation service coverage. However, this analysis was limited to only one year of coverage data, and only a few states changed policies during their short study period.…”

Section: Introductionmentioning

confidence: 99%

Expansion of Medicaid Covered Smoking Cessation Services: Maternal Smoking and Birth Outcomes

Adams¹,

Markowitz²,

Dietz³

et al. 2013

MMRR

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Objective:To assess whether Medicaid coverage of smoking cessation services reduces maternal smoking and improves birth outcomes. Methods:Pooled, cross-sectional data for 178,937 women with live births from 1996 to 2008, who were insured by Medicaid in 34 states plus New York City, were used to analyze self-reported smoking before pregnancy (3 months), smoking during the last 3 months of pregnancy, smoking after delivery (3-4 months), infant birth weight, and gestational age at delivery. Maternal socio-demographic and behavior variables from survey data and birth outcomes from vital records were merged with annual state data on Medicaid coverage for nicotine replacement therapies (NRT), medications and cessation counseling. Probit and OLS regression models were used to test for effects of states' Medicaid cessation coverage on mother's smoking and infant outcomes relative to mothers in states without coverage.Results: Medicaid coverage of NRT and medications is associated with 1.6 percentage point reduction (p<.05) in smoking before pregnancy among Medicaid insured women relative to no coverage. Adding counseling coverage to NRT and medication coverage is associated with a 2.5 percentage point reduction in smoking before pregnancy (p<.10). Medicaid cessation coverage during pregnancy was associated with a small increase (<1 day) in infant gestation (p<.05). Conclusions:In this sample, Medicaid coverage of smoking cessation only affected women enrolled prior to pregnancy. Expansions of Medicaid eligibility to include more women prior to pregnancy in participating states, and mandated coverage of some cessation services without co-pays under the Affordable Care Act (ACA) should reduce the number of women smoking before pregnancy.

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“…In addition, systematic reviews of pay-for-performance schemes that are targeted at doctors suggest that financial rewards can improve the quality of care. 2,25 On the basis of these studies, it would seem reasonable to conclude that the QOF is likely to have effected changes in utilisation that would make payments cost-effective. However, the QOF may also have had unintended consequences, such as encouraging inappropriate 'exception reporting' of patients to improve apparent performance.…”

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

Value for money and the Quality and Outcomes Framework in primary care in the UK NHS

Walker

Mason²,

Claxton³

et al. 2010

Br J Gen Pract

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The Quality and Outcomes Framework (QOF) is a pioneering attempt to improve the quality of primary care in the UK through the use of financial rewards. Despite its achievements, there are concerns that the QOF may offer poor value for money. AimTo assess the cost-effectiveness of QOF payments. Design of studyEconomic analysis. SettingEngland, UK. MethodCost-effectiveness evidence was identified for a subset of nine QOF indicators with a direct therapeutic impact. These data were then applied to an analytic framework to determine the conditions under which QOF payments would be cost-effective. This framework was constructed to assess the costeffectiveness of QOF payments by modelling the incentive structure using cost-effectiveness thresholds of £20 000 and £30 000 per quality-adjusted life year (QALY) gained, to represent good value to the NHS. It used 2004/2005 data on the QOF performance of all English primary care practices. ResultsAverage indicator payments ranged from £0.63 to £40.61 per patient, and the percentage of eligible patients treated ranged from 63% to 90%. The proportional changes required for QOF payments to be cost-effective varied widely between the indicators. Although most indicators required only a fraction of a 1% change to be cost-effective, for some indicators improvements in performance of around 20% were needed. ConclusionFor most indicators that can be assessed, QOF incentive payments are likely to be a cost-effective use of resources for a high proportion of primary care practices, even if the QOF achieves only modest improvements in care. However, only a small subset of the indicators has been considered, and no account has been taken of the costs of administering the QOF scheme. Keywordscost-effectiveness; family practice; health care; physician incentive plans; quality indicators.

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Medicaid reimbursement for prenatal smoking intervention influences quitting and cessation

Cited by 31 publications

References 25 publications

Disparities in Maternal Child and Health Outcomes Attributable to Prenatal Tobacco Use

Disparities in Maternal Child and Health Outcomes Attributable to Prenatal Tobacco Use

Expansion of Medicaid Covered Smoking Cessation Services: Maternal Smoking and Birth Outcomes

Value for money and the Quality and Outcomes Framework in primary care in the UK NHS

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